The researchers found that 44% of participants were not prescribed an OAC at discharge even though the median CHA2DS2VASc score was 5. Fall risk, poor prognosis, bleeding history, participant or family refusal, older age, and dementia were the most frequent (non-mutually exclusive) physician reasons for not prescribing OAC. The most important independent predictors of nonuse of OACs were older age and disability. By one year, 42.5% and 19.1% of those not receiving an OAC and receiving an OAC at discharge had died, respectively (P <.001).

"To improve anticoagulation decisions and outcomes in this population, future research should focus on strategies to mitigate fall risk, improve assessment of risks and benefits of anticoagulation in individuals with atrial fibrillation, and determine whether newer anticoagulants are safer in complex elderly and frail individuals," the authors wrote.

Disclosures: Several authors disclosed financial ties to the pharmaceutical and health care industries.